Answers To Your Questions About Care of the Intact Penis in the Geriatric / Disabled Population

from the

National Organization of Circumcision Information Resource Centers

Educating A New Generation For The Well-Being Of All Children.

www.nocirc.org

What is the foreskin?

The foreskin — also known as the prepuce — is the fold of skin that normally covers and protects the glans of the penis.

The foreskin's inside fold is mucous membrane, like the inside of the
mouth, and keeps the surface of the glans soft, moist, and sensitive.

The foreskin contains a rich supply of blood vessels and a dense concentration of specialized sensory nerve endings.

Specialized erogenous tissue, the ridged band, encircles the foreskin
at the mucocutaneous junction (where the inside and outside of the
foreskin meet).

The frenulum, the fold of tissue on the underside of the penis, secures the foreskin in its forward position.

How should I clean the intact penis?

First, explain to the patient that you are going to wash his penis.
Wash the outside with mild soap and warm water. Rinse. Gently retract
the foreskin, rinse the inner fold of the foreskin and glans with warm
water only (no soap on the mucous membrane), then return the foreskin
to its forward position. Dry the outside of the penis shaft and
foreskin. Residual soap may cause burning or discomfort.

How often should the foreskin be washed?

The inner layer of the foreskin and glans should be washed during a
bath or shower. The foreskin does not need to be washed after each
urination.

Should I use soap?

As with the inner labia of women, soap should never be used on the
inner folds of the male foreskin or the glans. Soap destroys the
natural bacterial balance, encouraging an overgrowth of yeast, and it
may cause an uncomfortable burning sensation.

What is the best way to reduce odor?

Unwelcome penile odors are caused by poor diet and poor general
hygiene. Encouraging patients to drink more water, eat more fresh
fruits and vegetables, and eliminate sugary processed foods from their
diet will inhibit the growth of odor-producing fungi and bacteria.
Frequent and thorough washing of the entire ano-genital area is equally
important. When washing the penis, gently rinse the outside of the
foreskin with mild soap and water. Rinse the inside of the foreskin and
glans with warm water to reduce odor if it is detectable.

How should I clean my patient's penis if his foreskin does not retract?

No special care is necessary. The swirling of the sterile urine under
the foreskin usually keeps it clean. If it seems necessary, the inside
of the foreskin may be irrigated by inserting the spout of a bulb
syringe filled with lukewarm water into the tip of the foreskin to
flush out the area.

What causes adhesions and how should they be treated?

Adhesions are formed when two raw areas of tissue come into contact and
adhere to one another during healing. Adhesions between the foreskin
and glans are usually benign. Leave them alone unless they cause a
noticeable accumulation of sloughed cells or cause the patient
discomfort during erection. Should they require separation, a physician
can apply an anesthetic ointment and lyse the adhesions with a scalpel.
Application of an antibiotic ointment and gentle retraction twice daily
will help to ensure that adhesions do not reform.

My patient complains of pain when being cleaned. Why? What can be done about it?

The cause of pain must be determined. Ask the patient what part of his
penis hurts. Common causes of pain are: vigorous retraction or
replacement of the foreskin, a rough wash cloth, rapid washing or
scrubbing, and soap on the inner fold of the foreskin, the glans, or in
the urethra. Once the cause is determined and the actions that cause
the pain are discontinued, the problem should cease. If your patient
continues to complain of pain, consult his physician.

Pain and odor may also be caused by yeast infections due to antibiotic
therapy, use of soap on mucous membrane, improper diet, and/or a
compromised immune system. Bacterial replacement therapy - injesting
and applying liquid Acidophilus culture or live-culture yogurt to the
foreskin several times a day - will quickly restore the body's health.
Acidophilus culture can be purchased in liquid form at a health food
store. Contact NOCIRC for additional information.

The doctor recommends circumcision. Are there alternatives?

Circumcision is most likely unnecessary and there are many
alternatives. The foreskin is a normal part of the body and, if there
is a problem with it, the cause of any problem needs to be determined
and addressed. Alternative solutions will depend on what is causing the
problem, for example, using bacterial replacement therapy for yeast
infections or using steroid cream for phimosis if it is problematic.
Contact NOCIRC for additional information.

What are the risks with adult circumcision?

The risks of adult circumcision are the same as the risks of infant
circumcision: hemorrhage, infection, surgical mishap, and death. For an
elderly patient, undergoing anesthesia adds to the risk. In addition, a
normal, protective part of the body is lost with circumcision.
Circumcision is also highly traumatic and can leave patients with
severe discomfort for weeks or even months following the surgery.

Are there medical indications for a circumcision?

A circumcision is medically indicated for the following rare
conditions: malignancy, gangrene, irreparable physical trauma to the
foreskin, or frostbite.

What shall I do if my patient has phimosis?

Phimosis is the term commonly used to refer to a foreskin that is
either long or difficult to retract. As males age, the foreskin often
seems to increase in length as the penis shrinks. It is also normal for
the foreskin to become increasingly resistant to retraction. These are
natural aging processes and do not require treatment of any kind.
Attempts at retraction of the narrowed foreskin cause unnecessary and
unjustifiable pain and suffering. Thankfully, it is entirely
unnecessary to retract the foreskin for purposes of hygiene. Using a
bulb syringe, simply irrigate the preputial space with warm water. If
it should ever become medically necessary to retract the narrowed
foreskin, wrap the penis in towels that have been soaked in warm water.
This simple preliminary step will greatly increase the comfort of the
patient during the retraction process.

What shall I do if my patient has paraphimosis?

If the foreskin is so severely retracted that it becomes stuck behind
the glans and cannot be returned to its normal place over the glans
(paraphimosis), gently compress the glans with the thumb and forefinger
placed on the corona glandis (the widest part of the glans penis). The
glans is composed of spongy tissue that can be squeezed to a surprising
degree without causing any discomfort or injury, even if erect. Once
the circumference of the corona glandis is sufficiently reduced, the
foreskin can easily slide back into place. A bit of petroleum jelly
spread over the expanded lips of the retracted foreskin will greatly
facilitate reversion and restoration.

"Nature is a possessive mistress, and whatever mistakes she
makes about the structure of the less essential organs such as the
brain and stomach, in which she is not much interested, you can be
sure that she knows best of the genital organs."